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Full text of "United States Navy Medical News Letter Vol. 27, No. 12, 22 June 1956"

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NavMed 369 

Editor - Captain L. B. Marshall, MC, USN (RET) 

Vol. 27 

Friday, 22 June 1956 

No. 12 


MEMORANDUM for All Officers of Medical Department of U. S. Navy ... 2 

Medical Appraisal of Transaortic Commissurotomy 6 

Evaluation of Methods of Treatment of Essential Hypertension. 9 

Radioactive Iodine in Diagnosis of Thyroid Disease . \\ 

Primary Atypical Nonbacterial Pneumonia 12 

The Traumatic Abdomen . 14 

Pregnancy and Cardiac Operations 15 

Carcinoma of the Prostate Treated with Radioactive Materials 17 

Porphyria and Chlorpromazine jg 

The TPI Test in the Navy. 19 

Submarine Medicine Practice , 20 

Training for Duty on Nuclear Powered Submarines 21 

From the Note Book 21 


Increase in Applications for Appointment 24 

Appointments in the Regular Navy 24 

Letters Received in Dental Division 25 

Status of Inactive Dental Licenses in California 26 

Procedures for Reserve Pay Units 26 


New Requirements for Promotion . . . . . 27 


Oxygen - Both Types . 33 

New OpNav Instruction , 34 

Experiments Relating Fabric Types with Severity of Burns 37 

Fatal Decompression Sickness , 38 

Do the Eyes Have It? '. , [ [ 39 

Medical News Letter, Vol. 27 No. 12 



Ref: (a) Memorandum BuMed: rasg NH/A3-4 of 26 April 1955 

1. ' About a year ago I addressed to all officers of the Medical Department 

of the Navy, a memorandum in which I outlined some of the specific objectives 
toward which I would strive during my tenure of office as Surgeon General of 
the Navy. For the most part these objectives were directed toward improving 
the attractiveness of a career in the Medical Department of the naval service, 
thereby making it possible to provide higher standards of medical care for 
our Naval and Marine Corps personnel and their dependents. 

2. I think it is now appropriate to bring you up to date on the successes 
and failures we have encountered so far and I will discuss separately each 
of the objectives enumerated in paragraph four of reference (a). 

a. The first objective I mentioned was that of obtaining a policy per- 
mitting unrestricted voluntary retirement after 20 or more years of active 
military service. As of the present time we have had 32 applications from 
individuals with more than 20 but less than 30 years' active service and all 
have been approved. Not all of these requests for retirement could be made 
effective on precisely the date desired by the individual, due to the necessity 
of providing a suitable relief for them. In the future it is suggested that those 
who wish voluntarily to retire after 20 years' or more active service, make 
their plans sufficiently far in advance so that the Bureau can conveniently 
arrange for ordering in reliefs. 

b. The second objective I sought was an increase in pay for doctors 
and dentists on active duty in the Navy, particularly for career officers. 
Proposed legislation to accomplish this was recently enacted into law (Public 
Law 497 - 84th Congress) and it is hoped this measure will retard the resig- 
nation and early retirement rates and that it may encourage civilian physicians 
and dentists to seek a career in the naval service. If such a trend develops it 
would aid substantially in terminating, eventually, the need for doctor draft 

c. The third objective pertained to stabilizing the length of tours of 
duty with a view to reducing the frequency of transfers. In this we have been 
able to achieve only a partial success and the reasons are numerous. Approx- 
imately 65% of our active duty physicians and 60% of our active duty dentists 
are reserves whose period of obligated service is from 18 to 24 months. 
This creates a serious problem due to the rapid turnover of personnel. To 
maintain essential hospital services it has at times been necessary to transfer 

Medical News Letter, Vol. 27, No. 12 


career medical and dental officers prior to the three- or four-year tour of 
duty which we have established as a desirable standard. We are continuing 
to explore every possible means of reducing this turnover and with the passage 
of legislation to improve career incentive, this problem may ultimately be 

d. Our efforts to reduce the length of tours of sea duty have met with 
considerable success and will be implemented beginning the first quarter of 
next fiscal year when the new influx of medical officers are indoctrinated and 
become available for sea duty. Except for flight surgeons whose specialty 
training is so intimately related to carrier assignments, and certain other 
categories of medical and dental officers, we plan to return to a 12- to 15- 
month tour of sea duty followed by' a shore duty assignment, or the reverse 

e. The fifth objective — consolidation of medical activities to utilize 
more effectively our Medical Department personnel— is not a dramatic one, 
nor is it of great importance in any single instance, but the total of man 
hours saved among the several consolidations which have been effected is 
definitely significant. In addition, the extra dividends which have accrued 
from this program such as improved morale of Medical Department officers 
and economy of medical material, have been most beneficial. 

f. The program for utilizing civilian physicians in navy industrial 
activities has expanded from a small beginning of 18 physicians employed on 
31 December 1954 to the point where as of 30 January 1956 we had 70 civilian 
physicians on the payrolls. This too has had a salutary effect on the morale 
of some of our military physicians and in addition offers promise of improving 
continuity of our industrial medical program. 

g. One of the major contributions your Bureau has made this past year 
has been in helping to develop proposed legislation to provide for dependent 
medical care. So much of our personnel planning and budgetary problems 
revolve around dependent "medicare" that I considered it one of the para- 
mount legislative problems to be resolved, second only to the career incen- 
tive measure. A bill providing for dependent care was recently passed by 
the House and more recently by the Senate and we hope that when enacted 
into law it will establish a workable basis for providing the medical care to 
which our military dependents are entitled. Undoubtedly there will in the 
future be modifications to this law and the regulations pertaining thereto, but 
at least it offers something definite upon which we can base our personnel and 
logistic plans. 

h. In strengthening the reserve components of the Medical Department 
we have been quite successful. Public Law 305 of the 83rd Congress (Reserve 


Medical News Letter, Vol. 27, No. 12 

Officers Performance Act) improved promotional opportunities for all re- 
serve officers. Just recently there was appointed by the Secretary of the 
Navy a board to study the entire promotional pattern of reserve officers. 
This board is headed up by Vice Admiral F. L. Johnson, USN. Within 
the past two months we have had the number of billets for the Ensign 1995 
(Senior Medical Student) Program increased from 100 to 200. Ensigns so 
appointed are obligated to accept appointment in the Regular Navy when ten- 
dered. Of specific interest to reserve medical and dental officers is the fact 
that during the last selection boards authority was granted to promote all 
reserve officers on inactive duty who met the qualifications for selection with- 
out being restricted by a percentage basis. 

i. When the Department of Defense-sponsored medical and dental 
scholarship program was submitted to Congress for their approval, the 
Medical Departments of all three military services testified in support of the 
plan which would provide for subsidization of medical and dental students by 
federal funds in return for obligated military service. The bill failed to re- 
ceive Congressional approval but may later be modified and reintroduced. 
It is, however, one of the areas where we did not meet with success. 

j. Our objective of expanding our training program has been distinctly 
successful and it is personally gratifying to report to you that not only has the 
scope of the program been enlarged, but that its popularity has been markedly 
enhanced. We have increased the number of naval internships available from 
176 to 200 and all have been filled under the National Internship Matching 
Program. Our residency training program now includes some 340 physicians 
in or approved for training as compared with 140 a year ago. The number of 
short courses authorized has been increased by about 50% and within the past 
twelve months we were able to budget some $36, 000 to pay for travel and per 
diem for some of those taking the short courses where travel is required. 
There has also been a 10% increase in the number of physicians in our flight 
training program. 

k. The objective of furthering research and publication of professional 
reports has kept pace with the expansion of our training program. Specific 
figures are difficult to obtain in this regard but my impression is that over- 
all there has been a gratifying broadened interest in these fields. 

!• At the present time the Surgeon General's policy board has under 
study certain proposed changes for Chapter 11 of the Manual of the Medical 
Department which are designed to strengthen the position of the executive 
officers of our hospitals by emphasizing their professional responsibilities . 
and at the same time to strengthen the position of our Medical Service Corps 
administrative officers in naval hospitals by transferring to them some of the- 

Medical News Letter, Vol. 27, No. 12 

administrative responsibilities now assigned to the executive officers. When 
final delineation of these responsibilities is made and the Manual changed 
accordingly I feel certain that the role played by both the doctor and the Med- 
ical Service Corps officer will permit greater utilization of their special 

3, I am sure you must be aware of the many difficulties which have come 
up over the past two years in our efforts to maintain the traditionally high 
standards of Navy medical care. That we have been able to carry on in that 
tradition is due in large part to your individual unselfish efforts and for this 
I want to extend to you not only my personal appreciation but also that of the 
entire Navy Department. 

B. W. Hogan 

Surgeon General, U. S. Navy 

****** jfx. 


The U.S. Navy Medical News Letter is basically an official Medical 
Department publication inviting the attention of officers of the Medical 
Department of the Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to medicine, dentistry, 
and allied sciences. The amount of information used is only that necessary 
to inform adequately officers of the Medical Department of the existence 
and source of such information. The items used are neither intended to be 
nor are they susceptible to use by any officer as a substitute for any item or 
article in its original form. All readers of the News Letter are urged to 
obtain the original of those items of particular interest to the individual. 

Change of Address 

Please forward requests for change of address for the News Letter to: 
Commanding Officer, U.S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Mi, giving full name, rank, corps, and old and new 



Medical News Letter, Vol. 27, No. 12 
Medical Appraisal of Transaortic Commissurotomy 

The first surgical method to correct commissural fusion of rheumatic 
aortic stenosis was conceived and employed by Bailey in 1950. It was termed 
trans ventricular commissurotomy because the operation required an entrance 
into the left ventricular cavity through its muscular wall for the passage of 
a dilator which engaged the valve from below and forcefully separated the 

The recent review by Likoff and associates of the clinical results of 
this technique in 79 patients, 65 of whom had aortic stenosis alone or com- 
bined with adynamic aortic regurgitation, reported an immediate operative 
mortality of 18% when the stenosis was not associated with other significant 
valve defects, and cited ventricular fibrillation as the most frequent cause 
of death. The clinical improvement after surgery was most encouraging, 
but it was tempered by a dynamic aortic regurgitation produced in 7% of the 

It has been reasonable to suspect that these unpredictable deterrents 
to the growing promise of the surgical management of aortic stenosis origin- 
ated in large measure from the operative technique which required direct 
trauma to the hypertrophied left ventricular myocardium and did not allow 
the surgeon to control the dilator digitally at the very site of its critical 

In the interest of avoiding these patent weaknesses, and what appeared 
to be their unfavorable consequences, the transaortic commissurotomy was 
developed. This procedure avoids myocardial injury by permitting the sur- 
geon to enter the lumen of the aorta through an artificially created pouch, 
and to reach the valve without unusual blood loss in order to split the com- 
missures under direct digital guidance. 

The success of cardiac surgery in modifying the devolutionary pattern 
of any stenotic valve lesion resulting from rheumatic activity depends upon 
the ability to alleviate the obstruction without unusual risk and without creat- 
ing new and serious defects. The accomplishment is measured by comparing 
the clinical and physiologic manifestations of the disease before and after 
surgery against the background of their usual progress under conventional 
medical management. 

Although an initial appraisal of transventricular commissurotomy 
concluded that the technique relieved obstruction and granted clinical improve- 
ment to the large majority of patients who did not obtain equal benefit under 
carefully regulated medical routines, it also recognized a considerable 
operative rijsk and the disturbing possibility of producing significant aortic 

A comparison of the operative mortality of both methods reveals that 
the 10% risk of transaortic commissurotomy is a distinct improvement and 
compares favorably with the 8% death rate of mitral commissurotomy. 

Medical News Letter, Vol. 27, No, 12 


That a digitally controlled means of splitting aortic commissural fusion 
is not an absolute safeguard against the hazard of producing significant regur- 
gitation, is disappointing. However, this is consistent with the experiences in 
mitral valve surgery and is a reflection of the many factors contributing to 
that complication, including the structural characteristics of the leaflets, the 
degree of calcification, and the skill and restraint of the surgeon. 

Because all patients chosen for surgery had had prolonged experiences 
with medical management and a basic knowledge of the format of their dis- 
ease, the postoperative improvement in dyspnea, fatigability, angina, syncope, 
and vertigo, which has been reported, is important confirmation of the effec- 
tiveness of the surgical management of aortic stenosis. Particular note must 
be made of the consistency with which angina disappeared following operation. 

The transortic method has not extended the percentage of patients im- 
proved or the degree of their benefit. From this it may be concluded that 
this or the transventricular procedure, successfully concluded, will result 
in equal success. 

However, it is clear that not all of the patients obtained significant 
clinical relief. In some instances, operation was rewarded only by a con- 
tinuing devolutionary state as ominous in its implications as the conditions 
dictating the surgical interference. When the error of creating a serious 
regurgitation is set aside, it is obvious that an important correlation exists 
between results, the morphology of the valve, and the ability of the surgeon 
to alter the size of the orifice. In short, transaortic commissurotomy does 
not permit the surgeon to overcome all of the handicaps imposed by the struc- 
tural abnormalities of the valve, among which extensive calcification and 
valvular thickening are most important. Although it remains true that the 
unyielding valve is technically more amenable to the direct transaortic approach, 
it is highly questionable whether in the majority of patients the improved effort 
is sufficient to turn the course of clinical events to a highly satisfactory result. 

The most significant changes in objective manifestations have been the 
decreased intensity of the rough systolic murmur, the increased intensity of 
the second aortic sound developing in over one -half of the patients, and the 
specific alterations in the brachial artery tracings. 

Transaortic commissurotomy does not extend or alter the basic indica- 
tions for the surgical treatment of aortic stenosis. The primary indication 
for operative interference is a combination of subjective or objective mani - 
gestations of significant and progressive pathophysiology resulting from the 
disease, provided none of the contraindications is present. 

When indications are outlined in such broad terms, further definition 


is required in order to properly apply basic concepts. Because dyspnea, 
angina, syncope, left ventricular enlargement, and the electrocardiographic 
pattern of left ventricular hypertrophy, and "strain" represent expressions 
of significant dynamic pathophysiology, patients with these findings clearly 
are candidates for operation. Within this clearly defined group, it is a 


Medical News Letter, Vol. 27, No. 12 

reasonable contention that aortic commissurotomy is performed more safely 
and effectively when the clinical manifestations are recent rather than late. 

A problem exists, however, with patients who are not symptomatic 
and who do not possess serious objective manifestations of their disease. 
Theoretically, these individuals represent ideal candidates for operation 
from a risk standpoint. However, it is conceivable also that they may sur- 
vive a full, unimpaired lifetime without surgery if the valve obstruction is 
adynamic and not progressive. A solution is envisioned when present inves- 
tigative studies clarify the correlation between valve areas, gradients across 
the orifice, and blood flow with the onset and ultimate progress of the mani- 
festations of aortic stenosis. 

The contraindications to operation are rarely in dispute. In general, 
they include those anatomic and physiologic issues which prejudice immediate 
recovery or serve as known deterrents to the benefit expected from surgery. 
A primary contraindication is the presence of additional significant incor- 
rectable valve lesions, outstanding among which is aortic insufficiency. 
Congestive heart failure, which does not respond to medical therapy, acute 
rheumatic activity, subacute bacterial endocarditis, and massive cardiac 
enlargement are absolute contraindications. 

Although age and the functional status of the patient have a direct 
relation to the risk of surgery and its ultimate benefit, fixed criteria in either 
regard cannot be outlined. For the present, the following scheme is suggested 
as an aid in the selection of patients: 

Group I. Patients with the auscultatory findings of aortic stenosis 
but without the symptomatic or objective expressions of the disease. Left 
heart catheterization rarely shows a significant systolic pressure grad- 
ient across the aortic valve. These individuals are not candidates for 
operation because there is no present knowledge that the anatomic lesion 
invariably leads to important pathophysiologic developments. 

Group II . Asymptomatic patients with left ventricular enlargement 
and/or left ventricular hypertrophy and "strain. 11 Left heart catheter- 
ization usually reveals a significant systolic pressure gradient across 
the aortic valve. Commissurotomy is indicated because of the presence 
of objective changes which presumably are progressive in nature. 

Group III. Patients with either dyspnea, angina, or syncope accom- 
panied by left ventricular enlargement and/or left ventricular hyper- 
trophy and "strain. " Left heart catheterization usually reveals a sig- 
nificant systolic pressure gradient across the aortic valve. Surgery is 
indicated because the clinical findings are manifestations of significant 
pathophysiology which presumably is progressive. 

Group IV . Patients with advanced clinical manifestations of aortic 
stenosis and congestive heart failure. Left heart catheterization rarely 
shows a significant systolic pressure gradient across the aortic valve, 
because of diminished cardiac output and intrinsic myocardial disease. 

Medical News Letter, Vol. 27, No. 12 


Although an operation may be performed, the risk is considerable and 
the accrued benefits may be minimal. 

In any of the operable patients indicated, the following conditions take 
precedence and surgery is definitely contraindicated: 

1. Significant incorrectable associated valve lesions 

2. Massive cardiac enlargement 

3. Acute rheumatic activity 

4. Subacute bacterial endocarditis 

5. Intractable congestive heart failure 

6. Serious complicating disease entities 

The material reviewed does not permit a final evaluation of transaortic 
commissurotomy. From these initial experiences, the operation has material- 
ly reduced the immediate mortality of the surgical treatment of aortic stenosis 
and offers the considerable advantage of a direct intimate examination of the 
valve area and its acquired pathology. The technique does not eliminate or 
reduce the possibility of creating significant aortic regurgitation, and its 
effectiveness is limited sharply by the morphology of the valve. In spite of 
these restrictions, transaortic commissurotomy is a striking therapeutic 
agent, entirely capable of modifying the clinical pattern and certain objective 
manifestations of dynamic aortic stenosis. (Uricchio, J. F. , et al. , A Medical 
Appraisal of Transaortic Commissurotomy: Ann. Int. Med. , 44- 844-859 Mav 
1956) — ' y 

* * * s|e * sjc 

Evaluation of Methods of Treatment 
of Essential Hypertension 

While it is generally accepted that about 95% of all hypertension is of 
the essential type, there still is no agreement regarding the etiology and the 
nature of the condition, despite the huge amount of study and writing on the 
subject. The types caused by renal, humoral, neurogenic, and a few other 
causes have been fairly well delineated. The old question regarding the 
relationship of essential hypertension to arteriosclerosis still remains un- 
answered. This failure does not indicate that no progress has been made in 
the knowledge of hypertention itself. Intensive research during the past 5 
years has resulted in the discovery of some potent drugs for lowering blood 
pressure. While no ideal agent has been found to be effective in all cases, 
several drugs are considered useful therapeutically in some instances. 

In evaluating the modern management of hypertension, it is not the 
purpose of this study to consider drugs only and their actions. Other methods 
of treatment, although well known , seem to have been half-forgotten and 
neglected. The failure of physicians to take adequate time to discuss fully 


Medical News Letter, Vol. 27, No. 12 

the significance of the individual's problems, the decreasing emphasis placed 
on the patient's habits, and the diminishing role of the diet in the control of 
hypertension are to be deplored. 

In evaluating the methods of treatment of hypertension, the use of 
drugs and their actions have been overemphasized to the neglect of other 
methods of treatment, such as the role of the diet and the psychosomatic fac- 
tors, e.g. , the patient's mode of living and habits. These points are given 
attention in this article along with the authors' experience with the newer drugs. 
Also considered is the surgical treatment of hypertension by means of sympa- 
thectomy and adrenalectomy. 

The new drugs alter one factor of the disorder, namely, high blood pres- 
sure itself, and generally fail, as far as is known, to modify some essential 
conditions which are a part of, the disease. This relationship of the high blood 
pressure to the metabolic, humoral, and vascular changes associated with it 
is one of the disputed questions of the day, and a short discussion is given. 

A classification of hypertension is presented because it is believed to 
be important in evaluating the patient with high blood pressure. It is empha- 
sized that in essential hypertension the hypotensive drugs are most applicable. 

To determine which patients are destined for early trouble and which 
may escape complications is difficult, but it is always safe advice to attempt 
to control excessive hypertension whenever it exists. General measures and 
symptomatic treatment are sufficient in many instances to control moderately 
high blood pressure. Attention to the patient's habits, more rest, more 
recreation, and less work may have beneficial effect. These are discussed. 

Reduction of calories resulting in reduction of weight often leads to a 
lowering of high blood pressure. Restriction of total intake of fat and cho- 
lesterol have been the chief factors in dietary regulation. 

Drugs, when used, should be introduced beginning with the milder agents, 
progressing to the more potent ones. In mild hypertension (grades I and II), 
mild hypotensive drugs should be used; in severe grades of hypertension 
(grades III and IV), more intense and potent agents in combination with the 
milder drugs to allay side reactions are used. 

The authors' experience with 59 selected patients, followed for periods 
from 4 months to 15 years both as outpatients and inpatients, is reviewed. 
The hypotensive drugs used in this study were Rauwolfia, hydralazine, Vera- 
trum, hexamethonium, and pentapyrrolidinium. The results parallel those 
of other authors in that gratifying blood pressure reduction with judicious 
drug use was observed. However, the authors believe that, while drugs 
definitely have a place in treating hypertension, they do not answer the prob- 
lem completely. Other factors such as stress also must be considered. 

Since the advent of the newer drugs,' indications for drastic surgical 
measures, such as sympathectomy, have further diminished. Considering 
the fact that the majority of hypertensive persons live useful lives without 
discomfort for many years, the group which should be subjected to surgery 

Medical News Letter, Vol. 27, No. 12 


becomes narrow. Adrenalectomy also has been reported as of aid in treating 
severe hypertension, but it is too early to evaluate ultimate results. (Murphy, 
F.D. , Schulz, E.G. , Evaluation of the Methods of Treatment of Essential 
Hypertension: Postgrad, Med., JL9: 403-415, May 1956) 

^5 s{c Jf: % }}: >j: 

Radioactive Iodine in Diagnosis of Xhyroid Disease 

A large number of procedures involving at one step or another the use 
of radioiodine are available for rather precise investigation of thyroid func- 
tion. This review analyzes briefly the major known reactions that take place 
during the formation, release, and degradation of the thyroid hormone and 
suggests how these reactions may be measured. In nearly all cases, the use 
of radioiodine is an important part of the determination and, in many instances, 
relatively simple procedures available in most isotope laboratories may be 
utilized for exact diagnoses. In particular, it is hoped that the fallacy of 
reliance on a single test for complete diagnosis of thyroid disease will be 
dispelled and the possibility of making a biochemical diagnosis suggested. 

Accompanying tables list a few of the commonly used tests of thyroid 
function which employ radioiodine. Many modifications of these tests have 
been used, but, in general, those listed in the table are relatively simple 
and give important data. The extrarenal disposal rate, the thyroid accumu- 
lation gradient, and the four- or six-hour uptake are all useful tests. In a 
recent publication, the relative efficiency of some of these tests in differentia- 
ting hypothyroidism and hyperthyroidism has been analyzed extensively. Two 
of the tests listed are rarely performed for clinical diagnostic purposes 
{thyroid "organification" of iodine and thyroid secretion rate). The thyroid 
organification of iodine is included because it is easily evaluated by thiocya- 
nate administration and may give important information not otherwise obtain- 
able. The thyroid secretion rate, which may be determined in several ways, 
is listed because it represents the final function of the thyroid and is depen- 
dent upon all the steps preceding it. Many of the data listed in the tables are 
taken from published studies. 

In the discussion, it has been tacitly assumed that complex and difficult 
tests of thyroid function, particularly those employing radioactive iodine, are 
not only necessary, but are also desirable for establishing the diagnosis of 
thyroid disease. This is true only in part. While it is certainly evident that 
careful biochemical diagnosis and the description of new syndromes of thyroid 
dysfunction require many or most of the tests mentioned, diagnosis of the 
average patient suspected of having thyroid disease does not depend on elab- 
orate function tests. Careful clinical judgment is still of paramount impor- 
tance in diagnosis. A detailed history, meticulous examination, and a certain 
degree of clinical acumen serve as the foundation for the diagnosis of thyroid 


Medical News Letter, Vol. 27, No. 12 

disease. In particular, repeated observation of the patient over a period of 
weeks or months frequently serves to confirm or exclude possible diagnoses. 
A further procedure, of which little is written, is the therapeutic trial. In 
patients suspected of hyperthyroidism, a course of treatment with iodine 
and frequent estimations of serum cholesterol and oxygen consumption, plus 
careful observation, will usually serve to establish or rule out a diagnosis 
of hyperthyroidism when most of the complicated laboratory procedures are 
equivocal or contradictory. Normal subjects given iodine in a dose of 50 mg. 
or so per day, will almost never show a rise in serum cholesterol and fall 
in the basal metabolism in the course of a few weeks. Patients with hyper- 
thyroidism and particularly those with Graves' disease, almost always show 
both a rise in cholesterol levels and a fall in the basal metabolic rate within 
two weeks of initiation of therapy with iodine. The use of desiccated thyroid 
or triiodothyronine and 1-131 uptake, to differentiate hyperthyroidism from 
euthyroidism, has been described and the results of such procedures are 
seen in the tables. The use of thyroid stimulating hormone has also been 
proposed to diagnose cases of minimal or potential hypothyroidism. Certain 
patients with just barely adequate thyroid function may fail to show an increased 
uptake of I- 1 31 after thyroid -stimulating hormone administration. This same 
lack of response to thyroid-stimulating hormone has been found also in almost 
all cases of Hashimoto's struma. 

The use of 1-131 for anatomic localization of thyroid tissue may fre- 
quently be helpful. Struma ovarii, lingual thyroids, substernal thyroids and 
occasional cancers of the thyroid may be diagnosed in this way. 

Radioactive iodine should be administered with discretion. It is impos- 
sible to administer radioiodine without delivering radiation to the thyroid 
gland. It should be borne in mind, therefore, that the administration of any 
tracer dose of radioiodine represents a calculated risk. It is a risk that is 
entirely justified if the information gained has a good chance of benefiting 
the patient. Radioiodine tracers to children especially should be viewed with 
considerable caution. (Rail, J. E. , The Role of Radioactive Iodine in the 
Diagnosis of Thyroid Disease: Am. J. Med. , XX: 719-729, May 1956) 

P r im a r y Atypical Nonbacterial Pneumonia 

Primary atypical nonbacterial pneumonia has emerged from relative 
obscurity to particular prominence during the past 20 years. Despite the 
increased frequency with which this disease is now recognized, there have 
been few large published series with adequate controls and serial clinical 
and laboratory studies which evaluate the efficacy of the various therapeutic 
agents presently available. 

This article reports a statistical evaluation of observations made on 
118 consecutive patients who had primary atypical nonbacterial pneumonia. 

Medical News Letter, Vol. 27, No. 12 


The planned study includes four groups of patients treated with various anti- 
biotics. They were compared with a control group which received no specific 
treatment. All patients had similar serial, clinical, laboratory, and roent- 
genologic examinations. Investigations were also performed to correlate the 
incidence of hemolytic anemia with primary atypical nonbacterial pneumonia 
and cold isohemagglutinins. 

The criteria for the diagnosis of primary atypical nonbacterial pneu- 
monia were identical with those of other investigators. The fundamental 
features were: 

1. Clinical history or respiratory tract disease characterized by gradual 
onset, cough, fever, chilly sensations, and, occasionally, substernal pain, 
usually without hemoptysis, abrupt onset, or an initial chill. 

2. Physical examination which frequently disclosed a disparity between 
the minimal pulmonary physical signs and the extent of pulmonary involve- 
ment exhibited by roentgenograms. 

3. Roentgenologic evidence of pulmonary parenchymal disease. 

4. Absence of cultural or serological evidence of known bacterial or 
viral agents in the etiology of the disease. 

The groups were named in conformity with the therapy received: 
Group 1, No specific therapy; Group 2, Chlortetracycline hydrochloride ther- 
apy; Group 3, Erythromycin stearate therapy; Group 4, Oxytetracycline hydro- 
chloride therapy; Group 5, Tetracycline hydrochloride therapy. 

Evaluation indicates that chlortetracycline hydrochloride, erythromycin 
sterate, oxytetracycline hydrochloride, and tetracycline hydrochloride do not 
alter the duration of pneumonitis in primary atypical nonbacterial pneumonia. 
Similarly, Walker demonstrated that chlortetracycline hydrochloride is without 
effect upon the manifestations of the disease in the pulmonary parenchyma. 
Homer and co-workers conclude that chlortetracycline hydrochloride and oxy- 
tetracycline hydrochloride have no effect on the duration of pneumonitis in 
primary atypical nonbacterial pneumonia. 

Although other investigators state that chlortetracylcline hydrochloride 
and oxytetracycline hydrochlorid are effective in the clinical treatment of 
this disease in man, and even inhibit the development of pneumonitis in cotton 
rats inoculated with a virus obtained from patients with primary atypical non- 
bacterial pneumonia, clinical practice has not always substantiated these 
claims. These studies demonstrate the ineffectiveness of the four antibiotics 
employed in influencing the duration of pneumonitis in primary atypical 
nonbacterial pneumonia. (LT R. L. Wolf, MC USNR, and CDR L. T. Brown, 
MC USN: Primary Atypical Nonbacterial Pneumonia - An Evaluation of the 
Efficacy of Antibiotic Therapy in One Hundred and Eighteen Cases: Arch. 
Int. Med., 97: 593-597, May 1956) 

* # # * # # 


Medical News Letter, Vol. 27, No. 12 

The Traumatic Abdomen 

This presentation is confined entirely to nonpenetrating wounds of the 
abdomen because these injuries present considerable difficulty in diagnosis 
and management. The author's findings follow: 

1. Any abdominal injury is serious and any person with abdominal 
trauma due to blunt force, even though first appearing slight, should be 
hospitalized because the clinical impression differs with the stage of the 

2. Since the severity of an injury can often not be determined immed- 
iately, the surgeon must "live with the case" until a definite diagnosis is 
made and definitive therapy has been carried out. 

3. Whenever possible, diagnostic procedures and the treatment of 
shock should be carried out simultaneously. 

4. In a moderate percentage of cases, multiple lesions are present. 

5. Pre-existing abdominal pathology, medical or surgical, may com- 
plicate the picture and increase the diagnostic difficulties. 

6. Early in the case, a ruptured viscus may produce few signs, and 
delayed rupture and late sequelae are relatively common. 

7. Delayed rupture presents not only a more difficult diagnostic prob- 
lem, but also presents a poorer prognosis and must be constantly kept in 

8. Conservatism does not have a conspicuous place in the management 
of these types of cases and in most instances it is much better "to look and 
see rather than to wait and see. " 

Of paramount importance in every case is the treatment of shock if 

1. Sufficient morphine should be given to relieve pain. 

2. If there is no chest or head injury, the foot of the bed should be 

3. Oxygen should be administered by nasal catheter after an open 
airway is assured. 

4. Blankets should be used, but one should avoid the detrimental effect 
of overheating. 

5. Administration of sodium chloride with 5% glucose should be begun 
at once, switching to plasma or plasma expanders if shock is without 

6. Whole blood should be started as soon as available if shock is due 
to hemorrhage. 

7. Levophed, Solu-Cortef, or similar agents may be indicated. 

8. The Levine Tube with suction is of particular value for several 

a. Diagnostic aid if blood is present in the stomach. 

b. Reduction of shock if gastric dilation is present. 

Medical News Letter, Vol. 27, No. 12 


c. Therapeutic help if a gastrointestinal rupture is present. 

d. Prophylactic against adynamic ileus, gastric dilation, and 
aspiration pneumonia. 

e. Aid in operative technique if abdomen is to be opened. 
Among some groups, a growing tendency exists to consider certain 

cases of abdominal injury — notably trauma of the liver and spleen with* 

shock controlled as not requiring surgical intervention. 

In the author's experiencej it is believed to be much safer in border- 
line cases to explore. True, the surgeon may do nothing after exploration, 
and true also, many would do well without surgery. The diagnosis, however, 
is so often in doubt, delayed rupture of hollow or solid viscera is so common, 
and multiple lesions are so frequent, that one had best "sin on the side of the 
right. " 

Even though the diagnosis is relatively certain and laparotomy is defin- 
itely indicated, the optimum time for exploration is often most difficult to 
determine, especially if the case is seen in severe shock. 

If response to shock treatment is satisfactory, and pulse and blood 
pressure remain stabilized for an hour or so, exploration is probably per- 

If response to treatment is evanescent, and a short period of recovery 
is followed by relapse, one must conclude that bleeding is continued and 
severe and that exploration should not be delayed. Blood should be avail- 
able in adequate quantities and should be running, preferably in two veins, 
when the incision is made. 

If treatment for shock has been adequate, continued, and intensive, and 
no response has been obtained, and the surgeon is relatively certain that 
nothing outside of the abdomen is responsible for the shock, the case is prob- 
ably hopeless. These cases are a distinct challenge to the surgeon and require 
some fortitude, but the author's opinion is that often nothing is lost, and 
occasionally a life may be salvaged, by exploration. 

The conclusion has almost been reached that with abdominal trauma, 
even in the presence of rib and vertebral fractures — often with severe hema- 
turia — with tenderness, spasm, and peritoneal rebound, regardless of a 
normal pulse, blood pressure, and count, the abdomen should be opened and 
an exploration done. (Cogley, J. P. , The Traumatic Abdomen: Indust. Med. 
& Surg., 25: 237-241, May 1956) 

Pregnancy and Cardiac Oper ations 

Obstetrical rehabilitation by cardiovascular surgery has reopened the 
question of risk for the pregnant patient with congenital or acquired cardiac 
disease. Insufficient time and experience limit knowledge essential to the 


Medical News Letter, Vol. 27, No. 12 

management of these groups. From observations made upon limited groups 
of patients who have had commissurotomy for mitral stenosis, optimistic 
views have been expressed. Obstetrical experience with patients who have 
congenital cardiac disease has been only scantily documented. 

This article reports data on 22 white patients who were subjected to 
various cardiac or cardiovascular operative procedures prior to, or during, 
pregnancy. Three categories are represented: mitral stenosis of rheumatic 
origin, 16 cases; tetralogy of Fallot, 3 cases; and patent ductus arteriosus, 
3 cases. All told, 51 pregnancies occurred: 26 prior to the surgical pro- 
cedure and 25 afterward. Six patients were operated upon while pregnant. 

The obstetrical management of patients previously subjected to cardiac 
surgery should be the combined effort of the cardiologist, cardiac surgeon, 
and obstetrician. Improved cardiac tolerance following operations should 
in no way detract from interest by any of the three services. The patient 
should continue to be considered in the category of the pregnant patient with 
heart disease and receive all the care and consideration usually given to this 
important group of patients. 

Prophylactic antibiotic therapy is considered advantageous during labor 
and delivery. In the authors' experience, vaginal delivery with minimal pre- 
delivery sedation, second stage forceps application, early episiotomy, and 
pudendal block anesthesia have been considered wise. 

Particular attention must be given to the immediate 12 -hour postpartum 
period. Tachycardia, orthopnea, and basal rales may forewarn of acute 
pulmonary edema of a sudden left heart failure. Large- volume infusions 
should be avoided and sodium intake restricted. 

The role of therapeutic abortion and sterilization for the cardiac patient 
has been simplified by the advent of successful cardiac surgery. Successful 
surgical results prior to or during pregnancy in any type of heart disease 
suitable for surgical treatment make the recommendation of these measures 
unnecessary, provided the patient can be restored to good functional activity. 
By the same measure, unsuccessful cardiac surgery in a patient severely 
limited in her physical activity prior and subsequent to operation is substan- 
tial evidence that she will poorly withstand the augmented hemodynamic burden 
of pregnancy and should be considered a candidate for therapeutic abortion 
and sterilization. No therapeutic abortion and sterilization board should 
consider the question of their intended function in any female patient with 
heart disease in the childbearing age, whether she is pregnant or not pregnant, 
without first obtaining the opinions of a competent cardiologist and cardiac 

Experience has demonstrated that for the three mentioned groups the 
potential gestational cardiac reserve was most accurately indicated from the 
degree of improvement resulting from the operation; that a successful opera- 
tive result usually indicated an excellent pregnancy potential while a lesser 
result was associated with cardiac deterioration during pregnancy. (Igna, E. J. , 
et al. , Pregnancy and Cardiac Operations : Am. J. Obst. & Gynec. , 71 :1024-1043, 
May 1956) 

Medical News Letter, Vol. 27, No. 12 17 


Carcinoma of the Prostate Tre ated. 
with Radioactive Materials 

During the past two and one -half years, the authors have had the oppor- 
tunity of using radioactive gold (Au 1 ^), chromic phosphate (P 32 ), and 
yttrium chloride (Yt^°) in the treatment of patients with carcinoma of the 
prostate gland. Although sufficient time has not elapsed to fully evaluate any 
of these materials, the authors believe it worthwhile to bring their results 
up to date and to get some indication as to how effective interstitial irradia- 
tion has been in treating these carcinomas. 

With a background of experimental work, the clinical use of radioactive 
materials was approached critically and cautiously. Patients were carefully 
chosen for injection and all cases are being followed. The majority of patients 
were treated at Chicago Wesley Memorial Hospital and the rest at the Veterans 
Administration Research Hospital where more detailed studies and follow-up 
were often possible. In addition to the ordinary laboratory studies routinely 
carried out at Wesley Hospital, it was possible at the Veterans Hospital for 
the Radio-Isotope Laboratory to study urinary excretion of radioactive sub- 
stance daily for the first 5 days following injection. Blood samples were 
also drawn at 1 -minute intervals for the first 10 minutes following injection, 
and regularly thereafter for 8 hours to determine blood levels of the isotope'. 
Liver function tests were done preoperatively. All of these Veterans Hospital 
patients are being brought back at 3-month intervals for repeat perineal punch 
biopsy, liver function studies, blood counts, and skeletal survey. 

During the period between April 1953 through August 1955, the authors 
treated 44 patients with carcinoma of the prostate, utilizing radioactive gold, 
chromic phosphate, and yttrium. 

The authors' experience to date with the use of radioactive gold in the 
treatment of prostatic carcinoma has led them to be somewhat less enthusias- 
tic and optimistic than other writers. Careful study of the course of the dis- 
ease in the patients reported has shown that, clinically, about one-half have 
been benefited by interstitial irradiation with gold. Benefit objectively has 
consisted of shrinkage and softening of the prostate as palpated rectally. In 
some instances, this has been dramatic to the point of almost "normal" rectal 
findings which have persisted for over 2 years following treatment. In other 
instances, more numerous, the rectal findings have shown definite improve- 
ment, but with persistence of some fixation and hardness. Subjectively, 
patients have shown improvement by cessation of sloughing and bleeding and 
greater ease of voiding associated with reduction of size of the local tumor 

The authors do not believe that it is possible to evenly distribute lethal 
doses of irradiation by present methods of injection. This has been brought 
out not only by autopsy material, but also by post-injection biopsies which 
have all been positive with two exceptions. They believe that intersitital 
irradiation with radioactive gold is potentially an effective and safe method 

18 Medical News Letter, Vol. 27, No. 12 

of destroying prostatic carcinoma, but as employed at present is not a curative 

Radioactive yttrium has been used in only 5 patients; in this study, exper- 
ience with this material indicates that results comparable to those obtained 
with gold are possible. Yttrium emits only beta irradiation of considerable 
energy and is much safer for patient and operator because of the absence of 
gamma rays. Although it is difficult to produce and obtain at present, the 
authors believe that further study of its use is warranted. Experimentally, 
yttrium was found to distribute itself more completely in regional lymphatic 
tissue, but, to date there has been no opportunity to study this clinically. 

Radioactive phosphorus, as employed in 5 patients, has failed to give 
satisfactory results. Again, the experience is too brief to draw conclusions, 
but is definitely discouraging. The occurrence of a serious complication, 
possibly from bone marrow irradiation, has c aused temporary abandonment 
of its use. 

About one -half of the patients with carcinoma of the prostate treated 
by injection of radioactive colloidal gold received some benefit. Two patients 
out of five, injected with radioactive yttrium chloride, received some benefit. 
Five cases, treated with radioactive chromic phosphate, failed to show any 
improvement and two of these patients have shown serious hematologic com- 
pile ations . 

Urinary excretion of the injected isotope varied considerably and oc- 
curred chiefly during the first 48 hours. Blood levels of isotope reached a 
peak within the first 3 minutes following injection and were surprisingly high 
in some cases. (Bulkley, G. J. , et at. , Present Status of Treatment of Carci- 
noma of Prostate with Radioactive Materials: J. Urol. , 75_: 837-845, May 

Porph yria and Chlorpromazine 

Porphyria reflects a fundamental disturbance in cellular metabolism, 
inborn or induced, and recognition of this disease complex in any of its varied 
forms is always a stimulating clinical event. 

Treatment of this curious condition in the past has been singularly 
ineffective and most frustrating. Thus, one recalls early but inconstant 
success with liver extract, vitamins, antihistamines, ganglionic blocking 
agents, ACTH, cortico-steroids and innumerable other agents aimed at con- 
trol of one or more distressing complaints. 

The purpose of this communication is to draw attention to the striking 
amelioration of symptoms and signs that has been observed during therapy 

with chlorpromazine. 

Monaco and Leeper (Brooklyn Hospital) have treated a 32 -year old 
married colored female for the past 15 months who exhibited typical hepatic 

Medical News Letter, Vol. 27, No. 12 


porphyria, with neurological and "nervous" signs and symptoms predominat- 
ing. During this time, chlorpromazine has consistently ameliorated and/or 
aborted symptoms and six attacks characterized by intense muscular and 
neuritic pains, nervousness, insomnia, weakness, and diplegia. Effective 
dosage has been in the range of 100-200 mg. daily in divided doses. 

Another case of hepatic prophyria, a 21 -year old white male, one of 
five members of a family with the "inborn error" being studied by Robbins, 
Leibow and Calvy (USNH, St. Albans), presented as a typical "abdominal" 
variant with complaints of severe abdominal pain and obstipation for 6 weeks. 
Dark urine was a recent observation. Strongly positive tests for porphobili- 
nogen and absence of uroporphyrin were noteworthy. Fecal pellets were 
passed after violent expulsive efforts at intervals of 7-10 days. Chlorpro- 
mazine 50 mg. t. i.d. resulted in prompt and striking relief of pain, dis- 
appearance of dark urine, and restoration of normal bowel function after two 
doses of the drug. The patient continued in an asymptomatic state. 

Three other members of the family with positive findings are under 
study and in two cases both uroporphyrin and porphobilinogen tests have been 
positive. A 22-year old sister died in a neighboring hospital 6 months ago and 
was a proved case of hepatic porphyria, acute intermittent type. Her past 
history revealed the trials of the person with porphyria, subjected to lapa- 
rotomy, dangerous sedation, and prolonged psychiatric care during a 3 -year 
intermittently symptomatic course. Her demise occurred after a short 
period of fulminating neurological disease. Further control studies relative 
to chlorpromazine are in progress with other members of this family. 

A recent communication from Dr. Cecil J. Watson corroborates these 
experiences with chlorpromazine and further validates its use in controlling 
the abdominal pain and nervous manifestations of acute porphyria. 

The mechanism of action is still obscure, but certain leads are pro- 
vided by chlorpromazine 's proclivity for inhibiting cytochrome oxidase 
(porphyrin containing) activity in brain mitochondria. Other enzyme systems 
are presumably involved. In any event, striking benefit of a continuing nature 
has been observed independently by several investigators. This represents 
a significant advance in therapy of this colorful but confusing disease and 
suggests use of chlorpromazine as a control measure of considerable value. 
(Captain G. L. Calvy, MC USN) 

The TFI Test in the Navy 

The Director of Laboratories, Naval Medical School, National Naval 
Medical Center, Bethesda, has pointed out that the article "The TPI Test 
in the Navy" published in the U.S. Navy Medical News Letter, Vol. 27, No. 6, 
page 35, 23 March 1956, may be subject to misinterpretation in that it pic- 
tures the test as being fully evaluated. As in the case of any new serologic 


Medical News Letter, Vol. 27, No. 12 

procedure, which has not withstood the test of time in broad general usage 
throughout the medical profession, the exact limitations of this test in dif- 
ferentiating syphilis from biologic false positives, and in detecting syphilis 
when other serologic tests fail, are still unknown. Efforts are now being 
made by the Public Health Service, Department of Health, Education, and 
Welfare, to critically compare a variety of serologic tests, including the 
TPI test^ in a number of laboratories. This study, if it is possible to com- 
plete it, may provide somewhat different answers from those that have been 
available in the past. Until new data are available, the interpretation of the 
results of the TPI test should be made with the understanding that the test 
is as yet not fully evaluated in all its limitations and, as in the case of all 
other laboratory tests, should not be the sole deciding factor as to whether 
a patient has syphilis or a biologic false positive reaction in a standard 
serologic test. It still provides a new and valuable aid to the clinician in 
reaching a decision as to whether or not his patient has syphilis, but cannot 
supersede clinical judgment. (Preventive Medicine, BuMed) 

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Submarine Medicine Practice 

The Correspondence Course Training Division of the U.S. Naval Med- 
ical School in cooperation with the Bureau of Naval Personnel has recently 
completed extensive revision of the publication known as Submarine Medicine 
Practice, NavPers 10838-A. 

This publication presents pertinent current information in Submarine 
Medicine which includes the medical aspects of both deep sea diving and the 
submarine service. Background information, as well as instruction con- 
cerning specific medical problems, is provided. Deep sea diving is dis- 
cussed under the following topics: the curriculum for submarine medical 
officer students; physical standards for diving duty; history of diving and its 
development in the U.S. Navy; diver's equipment and communications; aspects 
of physics, anatomy, and physiology pertaining to diving - particularly, the 
effects of pressure on the structure and functioning of the body; Navy standard 
decompression tables; the dive; helium -oxygen diving - physiological aspects, 
diving gear, and safety; self-contained underwater breathing apparatus - impor- 
tance, types, selection and training of personnel in its use, safety, medical 
problems, physiological considerations in design and evaluation, decompres- 
sion, oxygen tolerance, gas mixtures, and protective clothing and other 
accessories; diving without breathing apparatus. Life in submarines is dis- 
cussed with respect to habitability and clothing, personnel selection and 
assessment, escape, and medical problems of the present and of the future. 
With the rapidly growing interest in underwater swimming everywhere, this 
publication should be of value to all physicians. The discussions of diving 

Medical News Letter, Vol. 27, No. 12 


physiology and diving casualties are based on the considerable background 
of Navy medical officers specializing in these fields. 

The revision of the text upon which the new correspondence course will 
be based has been so extensively revised that a complete new set of questions 
will be required. It is possible that the new correspondence course will be 
ready for announcement and distribution in the fall of 1956; however, no 
applications for enrollment should be submitted to the Commanding Officer, 
U.S. Naval Medical School, until such time as the correspondence course is 
announced. In the meantime, anyone who may wish a copy of this publication 
for his own personal use may obtain it from the Superintendent of Documents, 
U.S. Government Printing Office, Washington 25, D. C. , at a price of $2. 00 
per copy. (Submarine Medicine Division, BuMed) 

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Training for Duty on Nuclear Powered Submarines 

A new program of training for duty aboard nuclear powered submarines 
has been arranged, beginning in September 1956. Submarine medical officers 
receiving this training will report to the University of Rochester where they 
may enroll in the Graduate School. Depending upon the particular courses 
taken, they may qualify for graduate degrees. The didactic course will last 
for the academic year and will be followed by a period of on-the-job training 
at a reactor site ashore or aboard an operating nuclear powered submarine. 
Anyone interested in the submarine medicine course and subsequent training 
for duty aboard a nuclear powered submarine should write to Director, Sub- 
marine Medicine Division, Bureau of Medicine and Surgery. (Submarine 
Medicine Division, BuMed) 

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From the Note Book 

1. The Navy Gross was recently awarded to Former Hospital Corpsman 
Third Class Alex J. Kitka, USN, for his extraordinary heroism while serving 
with a Marine Rifle Company in action against enemy aggressor forces in 
Korea on the night of July 16-17, 1953. 

The citation is from the President of the United States. (TIO, BuMed) 

2. Rear Admiral B. W. Hogan, MC USN, the Surgeon General, addressed 
the Surgical Section of the Scientific Assembly of the American Medical 
Association Annual Meeting held 13 June 1956 in Chicago. The Admiral's 
paper was entitled Psychosomatic Aspects of Surgery. 


Medical News Letter, Vol. 27, No. 12 

Admiral Hogan was also "Orator of the Day" at the Bunker Hill cere- 
monies, Charlestown, Mass. , on June 18, 1956, commemorating the 181st 
anniversary of the Battle of Bunker Hill. TIO, BuMed) 

3. Dr. Karl -Ernst Schaefer, Head of the Physiology Branch of the U. S. 
Naval Medical Research Laboratory at the Submarine Base in New London, 
received the 1955 Award for Outstanding Achievement in Medical Research 
from the Carbon Dioxide Research Association on May 3, 1956 in Chicago, 
at the annual meeting of the Association held in connection with the Congress 
of the American Psychiatric Association. (TIO, EuMed) 

4. A group of the Navy's research scientists working at the Naval Medical 
Research Laboratory, U.S. Naval Submarine Base, New London, has recently 
reported that their investigations prove that the near ultraviolet light emitted 
by fluorescent lights has no deleterious effect on dark adaptation and, there- 
fore, may be freely used for all shipboard installations. (TIO, BuMed} 

5. A BuMed exhibit entitled The Practice of Medicine in the Armed Forces 
was presented at the Annual Meeting of the American Medical Association in 
Chicago, the week of June 11-15, 1956. (TIO, BuMed) 

6. The U.S. Naval Dental Corps Casualty Treatment Training Program, 
"Mr. Disaster, "appeared at a meeting of the Northeastern Dental Society, 

held at Swampscott, Mass. , June 4-6, 1956. (TIO, BuMed) 

7. Dr. Hamilton Cameron, New York, announces the recently incorporated 
International Research Council, the first world-wide medical confraternity 
for the dissemination of knowledge concerning aphasias associated with 
hemiplegia. In January 1943, Dr. Cameron became one of the 600,000 hemi- 
plegia aphasics. He devised a Hand Talking Chart that has proven a practical 
clinical aid. This has been a boon to those vocally paralyzed who hitherto 
had no such means of communication with those around them. 

8. Systematic and continuous records on cancer for the entire State of 
Connecticut over the period 1935-1951 show significant progress in the 
attack against this disease which may be attributed to steady improvement in 
diagnosis and treatment. The Connecticut Cancer Record Register is unique 
in that it is the only known continuous record of all recognized cases of cancer 
collected from the total population of the state with a lifetime medical follow-up 
over so long a period. 

Two important broad observations concerning cancer in the Connecticut 
population were obtained from a study of the 75,494 cases recorded in the 
Connecticut Cancer Record Register. One is that cancer incidence rates are 
clearly higher for urban than for rural populations. The other is that experience 

Medical News Letter, Vol. 27, No. 12 


among the 2, 000, 000 people in this State corroborates the sharp increase in 
lung cancer among men that has been noted in the national population. (Conn. 
State Dept. of Health) 

9. The complications of infectious mononucleosis are closely associated 
with lymphocytic and mononuclear infiltration into the various organs and 
tissues of the body. A review of complications involving the neurologic 
system, spleen, liver, lungs, heart, mesenteric lymph nodes, kidney, eye, 
and skin is presented in Ann. Int. Med. , May 1956; J.N. Smith, Jr. , M. D. 

10. Twenty-six case histories are presented of patients with tears in the 
retina, without detachment of the retina; 40% of the patients did not develop 
a detachment; 20% did develop a detachment; and 40% underwent prophylactic 
surgery with successful results. To operate prophylactically is probably 
the safest course. (Am. J. Ophth. , May 1956; B. H. Colyear, Jr., M. D. , 
DK. Pischel, M. D. ) 

11. Seamless tubular prostheses made of compressed Ivalon sponge can 
be formed in any desired size and shape, with or without branches. A lim- 
ited number of these vascular prostheses have been implanted as aortic and 
arterial grafts in human patients and appear to have given satisfactory results. 
(Arch. Surg., May 1956; J. D. Mortensen, M. D. , J. H. Grindlay, M. D. ) 

12. Roentgenograph^ demonstration of lesions in the bones of hands and 
feet provides valuable corroborative evidence for the diagnosis of sarcoidosis. 
(Arch. Int. Med., May 1956, G.N. Stein, M.D., H. L. Israel, M. D. , and 

M. Sones, M. D. ) 

13. The hazards of hemorrhage in thoracic surgery are not only those due 
to the operation itself, but also to certain defects in coagulation which may 
arise during the course of the operation. The latter are thrombocytopenia 
and hypofibrinogenemia. The preoperative detection and correction of any 
hemorrhagic disorder which may be present, the control of hemorrhage 
during operation by careful surgical technique, the prevention of over as 
well as under transfusion by blood replacement on the basis of measurement 
of blood loss, and the judicious use of dextran are equally important in the 
management of patients undergoing major thoracic operations. Fresh plate- 
let preserved blood for thrombocytopenia, and fibrinogen for hypofibrino- 
genemia are recent improvements in the treatment of hemorrhage due to 
these causes. (Canadian Services Medical Journal, June 1956; P. G. Weil, 

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The printing of this publication has been approved by the Director of 
the Bureau of the Budget, 16 May 1955. 


Medical News Letter, Vol. 27, No. 12 



Increase in Applications for Appointment 

Sixty-five completed applications for appointment in the Dental Corps 
of the Regular Navy reached the Dental Division, Bureau of Medicine and 
Surgery between 1 January and 21 May 1956. Twenty applications are from 
Reserve Dental officers who have served on active duty for periods of 6 
months or longer. The remaining forty-five are from dental students who 
participated either in this year's Navy Senior Dental Student Program as 
Ensigns 1995 USNR on active duty, or who were selected for Naval Dental 
internships in fiscal year 1957. The sixty-five applications received by the 
Dental Division do not include those submitted as a result of the Medical and 
Dental Officers Procurement Act signed by President Eisenhower, 30 April 
1956. Such applications are being processed by the various offices of Naval 
Officer Procurement and the Bureau of Naval Personnel. However, the 
sixty-five applications make a good start toward increasing the strength of 
the Regular Navy Dental Corps from its present 762 officers to two-thirds 
of the active duty requirement in accordance with the purpose of the new 
Procurement Act. 

During May 1956, the Chief of Naval Personnel notified seven civilian 
dentists of their selection for appointment in the Dental Corps: 


Appointments in the Regular Navy 

Dr. Theodore E. Carlson 
1005 Stoughton Avenue 
Chaska, Minn. 

Dr. Robert E. Forner 
1607 Potomac Avenue 
Pittsburgh, Pa. 

Dr. Edward J. Copping, Jr. 
6907 5th Street, N. W. 
Washington, D. C. 

Dr. Joseph C. Gleeson, Jr. 
Cherry Valley Road, Rt. #2 
Princeton, N. J. 

Medical News Letter, Vol. 27, No. 12 


Dr. Theodore R. Hunley Dr. Alvin E. Riehl 

338 N. Montgomery Street 410 S. Third Street 

Spencer, Ind. Chaffee, Mo. 

Dr. Carl J. Swanson 
23303 Humber Lane 
Edmonds, Wash. 

Letters Received in the Dental Di vision 

Letters recently received by Rear Admiral R. W. Malone, DC USN, 
Assistant Chief for Dentistry and Chief, Dental Division, Bureau of Medicine 
and Surgery, are quoted: 

"Dear Admiral Malone: 

The present requirements for the American Board of Prosthodon- 
tics will be in effect for at least one more year, possibly longer. The 
only change is in the matter of the re -examination fee which has been 
increased to $200, the same as the original examination fee. This 
had to be done because of the cost of conducting the examination. 

As you no doubt have heard, the Council on Dental Education has 
indicated its desire to see all restorative dentistry under the Prosthetic 
Board. Efforts are being made to bring this about, but it will prob- 
ably be some time in its accomplishment. With very few exceptions, 
the Board finds the Navy Dental officers among the best prepared for 
the B oard, which is certainly a compliment to Naval Dental Training 
and a careful way in which these men are screened by the Bureau of 
Medicine and Surgery. 

Best regards, 

S. Howard Payne, Secretary 
American Board of Prosthodontic s" 

"Dear Admiral Malone: 

In replying to your letter of May 7, let me say that, at the meeting 
of the Board (of Periodontology) on February 7, 1956, the educational 
requirements for examination by this Board for candidates applying 
after that time were fixed at two formal academic years of education 
and training in periodontology and its supporting subjects in accept- 
able educational institutions. Very little discretion is left to the 


Medical News Letter, Vol. 27, No. 12 

Committee on Requirements for accepting equivalent education and 
training, that is, a miscellaneous series of short courses, teaching, 
hospital experience outside an acceptable residency, etc. 

The Council on Dental Education is undertaking to evaluate and 
accredit teaching hospital residencies in the various dental specialties. 
Neither the Council nor the Board has, up to thi3 time, tried to eval- 
uate formal graduate or postgraduate courses given by dental schools 
except where it was known that no competent periodontist was on the 

Sincerely yours, 

Harold J. Leonard, Secretary 

American Board of Periodontology " 

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Status of Inactive Dental Licenses in California 

The Executive Secretary, Board of Dental Examiners, State of Califor- 
nia, forwarded the following information to the Chief of the Dental Division, 
Bureau of Medicine and Surgery, 17 May 1956: 

"Please be assured that you will receive any information which will in 
any way alter the status of dentists that are currently on inactive status 
with this Board by virtue of their military service. There has been 
rumor to the effect that legislation may be introduced that would affect 
the status of dentists in the military service. However, in this regard 
and prior to any action that would jeopardize the standing of a dentist 
licensed by this board, we will make every effort to contact the doctor 
to the end that he may reactivate his license to practice in California. " 

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Procedures for Reserve Pay Units 

Bureau of Naval Personnel Instruction 1300. 3B prescribes the assign- 
ment and termination policies and procedures for pay units of the Naval 

This instruction applies to officers attached to, or associated with, 
pay units and carries pertinent information in regard to age limitations, and 
register numbers of senior officers in grade and corps who are eligible for 
the pay status. Perhaps the most important policy is that all officers in 
such pay status must be in the Ready Reserve or request transfer to the 
Ready Reserve for a period of at least one year. 

This instruction is effective as of 1 July 1956, but has been modified 
by BuPers Notice 1300 of 25 April 1956 to become effective 31 December '56 

Medical News Letter, Vol. 27, No. 12 


for those serving as instructors in the Ready Reserve programs. This 
instruction also applies to Reserve officers taking active duty for training. 

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Due to the critical shortage of medical officers, the Chief, Bureau 
of Medicine and Surgery, has recommended, and the Chief of Naval Person- 
nel has concurred, that Reserve Medical officers now on active duty who 
desire to submit requests for extension of active duty at their present sta- 
tions for a period of three months or more will be given favorable considera- 
tion. BuPers Instruction 1926. IB applies. 

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New Requirements for Promotion 

A new BuMed Instruction 1416.3, dated 12 May 1956, promulgates a 
plan to determine the professional fitness for promotion of all Reserve officers 
of the Medical Department {except Warrant and Chief Warrant officers who 
will be the subject of a future directive). 

In developing this plan, it was determined that all Reserve Medical 
Department officers, as appropriate to grade and category, should demonstrate 
professional qualifications by means of successful completion of examinations 
or progressive study in three broad areas: 

Executive. Understanding of basic principles and policies in the organ- 
ization of the Department of Defense and in the planning control, and admin- 
istration of the Naval Establishment. All officers of the Medical Department 
should have basic qualifications in this area. 

Operations. Knowledge of the professional subjects essential to the 
efficient operation and management of Medical Department activities appro- 
priate to the various officer grades and classifications. 

T echnical . Knowledge of the professional subjects essential to the 
efficient performance of duties characteristically assigned to the officers 
of the specific category within the Medical Department. In this area, the 
requirements will necessarily be differentiated between various established 
fields of professional endeavor. 

Medical News Letter, Vol. 27, No. 12 


Through the provisions of this instruction, Reserve Medical Depart- 
ment officers, other than Medical and Dental officers on Active Duty , must 
qualify for promotion by means of written examinations or completion of 
specified courses, including correspondence courses, in lieu of written 
examinations. Professional requirements for promotion of Reserve Medical 
and Dental Corps officers on Active Duty have been held in abeyance indef- 

The Reserve Medical Department officer on Inactive Duty is not required 
to take written examinations for promotion. To qualify for promotion, the 
inactive Medical Department officer must complete correspondence courses 
appropriate to his grade and category subject to the following provisions: 

1. Correspondence courses which are classified are not required, 
but may be taken if adequate stowage facilities are available. 

2. Correspondence courses administered by the Naval War College 
and Industrial College of the Armed Forces are not required, but the 
appropriate point credit may be obtained by officers who elect to take such 

3. In the event the correspondence courses listed in this plan for any 
given grade and category, subject to the provisions of (1) and (2) above 
do not provide the officer with an adequate number of promotion points in 
grade, additional courses may be selected from the approved courses 
outlined in the current catalog of Officers Correspondence Courses, Nav- 
Pers 10800. 

4. Ensigns will be guided in their selection of correspondence courses 
by those listed for Lieutenant (junior grade) to Lieutenant. 

5. Satisfactory completion of resident courses taken while on active 
duty, as listed in this plan, will be credited in lieu of correspondence courses 

6. Correspondence courses taken while on active duty will be credited 
toward the correspondence course requirements for inactive duty. 

7. Duplicate credit will not be given for promotion for the completion 
of a correspondence course listed for a subject for which the officer has 
already established his qualification by the method described in paragraph 
(5) above. 

8. In the case of alternate correspondence courses listed under one 
subject, credit for promotion will be given for only one course. 

Here is the plan for the promotion of Reserve Medical Corps officers 
on Inactive Duty only: 

Part I - Executive Area 

1. Administrative Organization and Regulations 

2. Personnel Administration and Leadership 

3. Military Justice 

Required for promotion to all grades of the Medical Corps. 

Medical News Letter, Vol. 27, No. 12 


Part I I - Operations Area 

1. The Medical Department of the Navy: LTJG-LT 

2. Operational Medicine: LTJG-LT 

3.. Bureau of Medicine and Surgery: LT-LCDR 

4. Medico -Legal Matters: LT-LCDR; LCDR-CDR; CDR-CAPT 

5. Retirement and Compensation: LT-LCDR; LCDR-CDR; CDR-CAPT 

6. Logistics: LCDR-CDR; CDR-CAPT 

Part III - Technical Area 

1. Medicine, General: LTJG-LT; LT-LCDR 

2. Surgery, General: LTJG-LT; LT-LCDR 

Pha sing Schedule for Reserve Medical Corps Officers 

Officers selected for promotion in the fiscal years indicated below 
must be qualified in the subjects listed in the appropriate column. Where 
a choice of subjects is indicated, the individual officer may choose the sub- 
jects (in the specified area). 

Subjects in which earned credits will be required: 

Fiscal Year in 

Which Selected LTJG-LT LT-LCDR 

1956 Any two subjects in Any two subjects in 

Executive Area Executive Area 

1957 All subjects in Execu- All subjects in Execu- 
tive Area tive Area 

1958 All subjects in Execu- All subjects in Execu- 
tive and Operations tive Area plus any two 
Areas subjects in Operations 


1959 All subjects in Execu- All subjects in Execu- 
tive Area and Operations tive and Operations 
Areas plus one subject in Areas 

the Technical Area 


Medical News Letter, Vol. 27, No. 12 

Fiscal Year in 

Which Selected LTJG-LT ET-LCDR 

1960 All subj ects in all All subjects in Ex ecu. - 

Areas tive and Operations 

Areas, plus one sub- 
ject in the Technical 

1961 and 

Succeeding Years All subjects in all All subjects in all 

Areas Areas 


!956 Any two subjects in Any two subjects in 

Executive Area Executive Area 

!957 All subjects in Execu- Any three subjects 

tive Area in Executive Area 

1( ?58 All subjects in Execu- All subjects in 

tive Area plus one Executive Area 

subject in Operations 


1959 A11 subjects in Execu- All subjects in Execu- 
tive Area plus any two tive Area plus one 
subjects in Operations subject in Operations 
Area Area 

!960 All subjects in Execu- All subjects in 

tive and Operations Executive Area plus 

Areas any two subjects in 

Operations Area 

1961 and All subjects in all All subjects in all 

Succeeding Years Areas Areas 

Correspondence Co urses 
Medical Corps Officers : 

Required for Promotion of LTJG to L.T, 


Medical News Letter, Vol. 27, No. 12 


Part I - Executive Area 


1. Administrative 
Organization and 

2. Personnel Admin- 
istration and 

3. Military Justice 

Cor respondence Course 

#Navy Regulations, Nav- 
Pers 10740-A 

*Security of Classified 
Matter, NavPers 

Leadership, NavPers 

* Military Justice in the 
Navy, NavPers 10993 

Part II - Operations Area 
1. Medical Department Medical Department 

of the Navy 

2. Operational Med- 

School Exemption 


*U. S. Naval School, 
Naval Justice 


Orientation, NavPers 
10943 -A 


Functions of Officers of 
the Medical Department 

Naval Preventive Med- 
icine, NavPers 10703 

Combat and Field Med- 
icine Practice, NavPers 


Atomic Medicine, Nav- 
Pers 10701-A 

Radiological Defense, 
NavPers 10771 

** Naval Medical School 
Preventive Medicine 
and Public Health 

Part Ill-Technical Area 

1. Medicine, General Clinical Laboratory Pro- 
cedures, NavPers 
10994, or 

^Residency in Med- 


32 Medical News Letter, Vol. 27, No. 12 


Correspondence Course School Exemption 

Tropical Medicine in 
the Field 


Special Clinical Services 
(Blood) NavPers 10998 

Frigid Zone Medical and 
Dental Practice, NavPers 


Submarine Medicine Prac- 
tice, NavPers 10707 

Aviation Medicine Practic e 
NavPers 10912 

Pharmacy and Materia 
Medica, NavPers 10999 

*Fellowship in the 
American College of 

*Board Certification 
in Specialty 

2. Surgery, General ^Residency in Surgery 


*Fellowship in the Amer- 
ican College of Surgeons 

*Board Certification 
within Specialty 

For Reserve officers of the Medical Department on inactive duty, 
the plan is effective on 1 July 1956, in that after this date, officers must 
select correspondence courses in accordance with the provisions of this in- 
struction. Promotion credits earned by those correspondence courses com- 
menced prior to 1 July 1956 are creditable toward promotion whether or not 
included in this instruction. 

Information concerning the promotion plan for other grades and cate- 
gories of Reserve Medical Department officers will be contained in future 
issues of this publication. 

* Qualifications for two grades 
** Courses to be developed 


Medical News Letter, Vol. 27, No. 12 


Oxygen - Both Types 

We've got a couple of angles for you this month on handling both gaseous 
and liquid oxygen. Possibly this is old stuff to many, but for the newcomers' 
we repeat the old saw: Read and heed. 

A recent Medical Information Letter from MATS reports that a technical 
sergeant at McGuire AFB was severely burned on both hands. He had been 
filling walk-around oxygen bottles from a central source in the maintenance 
area. When he plugged one of the bottles in, a fire started. Presumably, this 
resulted from some type of grease or oil on one of the fittings. 

We did a bit of experimenting on our own with bail -out bottles after 
receiving the above information. Key personnel at the San Bernadino Air 
Materiel Area (SBAMA) in the hydrostatic section hooked up a few bottles 
for us and demonstrated the absolute necessity for cleanliness. Every bottle 
and every fitting is examined carefully for foreign matter prior to refilling. 
As an additional safety precaution, personnel are required to scrub their 
hands thoroughly before working with the oxygen system. A greasy hand a 
squirt of O z , and BOOM! 

The SBAMA people showed us another gimmick that may prove helpful 
to you. Seems that they recently had to discharge, purge, and refill a num- 
ber of bail -out bottles that came in from another base. While they were in 
the process of getting the old oxygen out, a couple of flamers developed that 
sent the troops scattering. This was hardly the sort of thing to build up a 
man's peace of mind. 

After a bit of experimenting, it was discovered that a static line was 
the answer. Apparently a fairly rapid rate of discharge sets up a good charge 
of static electricity. They just run a line from the metal vise, holding the 
bottle, to a water pipe. Apparently it works, too, for they haven't had a 
flamer since using the rig. 

I t's colder than you think . Some of you are already working with liquid 
oxygen. As newer aircraft hit the line, there will be more and more of that 
particular commodity in use. Here's one thing to watch our for: Liquid 


Medical News Letter, Vol. 27, No. 12 

oxygen will freeze skin tissues and the results are similar to a severe burn. 
Never work with liquid oxygen with bare hands. Naturally, this means wear- 
ing gloves; however, they must be loosely fitted. If you happen to get some 
of the tricky stuff on a tight -fitting pair of gloves, it's going to freeze 'em 
right now; and then, to make a pun, you're really in a bind. Remember, 
too, that gloves can freeze before you realize it, so watch them carefully for 
frost spots. 

One last word of caution about liquid oxygen: If any splashes into the 
eyes, you're going to have a pair of frozen optics immediately. Goggles 
should be required. ( On the Line : Abstract, Aircraft Accident and Main- 
tenance Review, December 1955) 

3jC 3jc 5(» 

New OpNav Instruction 

After more than a year of study and revision, OpNav Instruction 
3750. 6B is now being printed and distributed. The effective date of this 
new Navy Aircraft Accident, Incident, and Forced Landing Reporting Proce- 
dure is 1 July 1956. 

There are several significant changes involving the participation by 
medical officers and flight surgeons in aircraft accident investigation and 
reporting procedures. These changes are enumerated below. Prompt and 
thorough compliance with this instruction is required to enhance the medical 
contributions to aviation safely. 

Part IV - Aircraft Accident Boards 

B. Com position of Aircraft Accident Boards 

1. In cases of major aircraft accidents, the aircraft accident board 
shall consist of at least four officers . . . one must be a medical officer 
(preferably a flight surgeon). 

2. In cases of minor aircraft accidents, the aircraft accident board 
shall consist of only one officer ... A medical officer (preferably a 
flight surgeon) shall be an additional member when circumstances require 
the submission of a medical officer's report of aircraft accident or when 
aeromedical factors are involved or suspected. 

Par t V - Aircraft Accident Investigation 

D- Spec ial Medical Requirements 

1. Examination by a Flight Surgeon Following an Accident 

a. The effectiveness of the medical examination of the pilot is 
increased when it is accomplished as soon as practicable following an 

Medical News Letter, Vol. 27, No. 12 


accident. Depending upon the condition of the pilot and the nature of the 
accident, the medical officer (preferably a flight surgeon) will determine 
the extent of the examination required. The object of this examination is 
to determine by means of examination, interview, and other methods, the 
aeromedical factors involved in the accident, as well as to treat the pilot 
and make recommendations to the commanding officer. 

b. Clinical laboratory procedures will be fully utilized in those 
instances where carbon monoxide poisoning, other toxic substances, and 
altered blood chemistry are suspected. The flight surgeon will be guided 
by BuMed instructions of the 6510 series in obtaining and submitting such 

Pathological Correlation. In those aircraft accidents where cau- 
sative or contributory pathology is reasonably suspected, the flight surgeon 
will make every effort to obtain an autopsy on the pilot. The flight surgeon 
will be guided by Chapter 17 of the Manual of the Medical Department and 
pertinent BuMed instructions. The autopsy report will be forwarded as a 
part of the Medical Officers Report {Opnav Form 3750. 8, Rev. 2-54) 
or submitted as a supplementary report (see Part VI, par. C.2.f. of this 

3. Flight Surgeon's Investigation and Analysis . The flight surgeon 
member of the accident investigating board will participate actively in 
all deliberations and field investigations of the board. His specialized 
talents shall be particularly directed toward uncovering underlying mental 
or physical factors contributing to the pilot-error and undetermined-caused 
accidents. Special instructions for the fl ight surgeon member of the air- 
craft accidenTboard are contained in the ''Handbook for Aircra ft Accident 
Investigation" NavAer 00-25-538 . ~~ 

Part VI - Reports Required 

C. Regular Reports Required 

2. The Medical Officer's Report 
a. Submission Requirement 

(1) Medical Officer's Report of Aircraft Accidents, Incidents, 
and Ground Accidents (OpNav Form 3750. 8, Rev 2-54) is submitted in the 
case of a major aircraft accident. 

(2) It will also be submitted on minor accidents, ground 
accidents, and incidents involving bailout or ejection of an aircraft occu- 
pant, or where the cause or contributory cause of the accident involved: 

(a) Psychological factors, such as anger, domestic 
difficulties, or other adjustment problems, fatigue, fear; human engineering 
such as use of wrong control, misreading instruments, inability to reach 
controls, et cetera; memory failure; errors in judgment (reaction time); 
et cetera. 


Medical News Letter, Vol. 27, No. 12 

(b) Physiological factors, such as anoxia, vertigo, 
decompression, temperature extremes, illness, noxious or toxic sub- 
stances, et cetera. 

(c) Safety and survival equipment factors, such as ejec- 
tion seat, G suit, pressure suit, oxygen mask, restraining harness, quick 
releases, helmets, et cetera. 

(3) The medical officer's report will also be submitted in the 
case of ground accidents involving fatal critical or serious injury; where 
toxic substances are involved; or where psychological or physiological 
factors are involved. 

b. Time Limit. The medical officer's report of aircraft 
accidents/incidents and ground accidents will be mailed within four (4) 
working days after the accident occurrence. 

c. Distribution. (The report continues to be prepared in quad- 
ruplicate . . . the original, however, is now mailed to the U.S. Naval 
Aviation Safety Center, Naval Air Station, Norfolk, Va. , Attn: Aero 
Medical Department . . . for Marine Corps activities, the report is 
prepared in quintuplicate. The fourth copy is submitted to the Commandant 
of the Marine Corps (Code AAP). ) 

d. Preparation. (Details of preparation do not differ markedly 
from the previous instruction. ) 

e. Enclosures. The following enclosures will be appended as 

(1) Report of autopsy 

(2) Laboratory report of tissue or blood analyses 

(3) Survivor's statement in the case of bailouts, ejections, 
ditchings, water crash, and survival cases, covering in detail these exper- 

(4) Photographs of any damaged safety or survival equipment, 
or of the accident scene to better describe the case. 

(5) Recommendations for corrective action 

(6) Reproduction of other material considered pertinent, such 
as health record extracts. 

(7) Summary and conclusions from socio-psychological inter- 
views and analysis of physio-pathological findings. 

f. Supplementary Reports. Where a full report cannot be sub- 
mitted in detail within four working days, the basic report will be submitted 
as required and supplementary information (such as lab reports, photo- 
graphs, autopsy report, et cetera) forwarded as soon as possible. Sup- 
plementary reports will be identified as follows: Supplementary Information 
on VF-00MOR serial 1-56 concerning F4U-4, 81654, accident occurring 

1 Jan 1956, pilot DOE. 

}[c sjc & sj; ajc sjc 

Medical News Letter, Vol. 27, No. 12 


Experiments Relating Fabric Types 
With Severity of Burns 

Because of military, industrial, and civil defense needs, a study of 33 
different fabrics was undertaken to determine what protection, if any, would 
be provided against exposure to flash burns or burns due to their clothing 
becoming ignited. Tests were carried out by covering clipped, anesthetized 
white laboratory rats with each fabric and exposing them to a temperature of 
of 2200° F over a one-inch diameter area for a period of 3 seconds, or by 
igniting a standard wick of the material and observing the resultant burns. 

Each fabric was tested on six separate animals and the burns which 
developed were followed both grossly and microscopically until healing was 
complete, Kodachrome photographs were taken weekly for graphic com- 

In 195 experiments in which the fabrics were heated to the ignition or 
melting point, it was noted that wool, asbestos, nylon, dacron, silk, or 
flame retardent treated cotton failed to support combustion or produce burns. 
Cotton/dacron and cotton/nylon yielded moderate burns which healed rapidly, 
as did acetate rayon or viscose rayon. Untreated cottons uniformly produced 
deep burns which healed slowly. Loose fitting garments proved far more 
dangerous than did those worn snugly. 

Flash burns were studied in 204 experiments and the following features 
found: (1) Heavier materials protect better than light-weight fabrics; (2) Fa- 
brics which melt, such as nylon, produce smaller burns than untreated cotton 
which chars beyond the exposed area; (3) Light colored fabrics offer more 
protection than dark; (4) Pyroset flame retardent treatment improved pro- 
tection of cottons, while the Bradford Dying Association treatment was less 
effecti ve; and (5) Cotton could be combined successfully with synthetic fabrics 
to get the best features of each. Flame retardent treatment of the combina- 
tion improves it slightly. (RCS WADC-U16: Activity Report from Aero Med - 
ical Laboratory , 6 February 1956) 

Resume of BuAer Program on Fire Retardent Treated Fabrics for Flight 

Initial investigations on the chemical fibers, orlon and nylon, proved 
unsatisfactory in that when a satisfactory treatment to offer fire retardency 
was obtained, the physical properties such as tear and breaking strength 
and sewability was reduced below the required minimum s for the fabric 
application. t 

Work was initiated on the investigation of cotton fabrics with moderate 
success. The initial work was accomplished on the standard summer flight 
suit fabric, 5.0 oz. cotton twill. This windbreaker type fabric was difficult 
to treat for fire retardency. However, two types of fire retardent compounds 


Medical News Letter, Vol. 27, No. 12 

were tried, and a "durable" type was applied to this fabric to give protection 
against flash fires. 

Work was done to obtain an air-permeable fabric of high strength with 
a durable fire retardent treatment. Such a fabric has been developed to give 
a good air permeability with durable fire retardency for the life of the fabric. 
This fabric is lighter in weight than the present standard fabric and affords 
more comfort to pilots in the summer flight suits. This fabric will be avail- 
able in stock in the near future. 

Evaluation work on fabrics has been conducted by the Aeronautical 
Materials Laboratory, Naval Air Material Center, Philadelphia, Pa. 

5(£ 5$! sfic 3$* 

Fatal Decompression Sickness 

An article entitled, "Fatal Decompression Sickness During Jet Air- 
craft Flight: A Clinic opathological Study of Two Cases, " by W. Haymaker, 
A. D. Johnston, and V. M. Downey, appeared in the February 1956 issue of 
the Journal of Aviation Medicine. This report is concerned with two nearly 
identical cases of collapse during jet aircraft flights. Signs of central ner- 
vous system damage were observed in both. The clinical course was ful- 
minant, with death occurring in 11-1/2 and 6 hours respectively. Both 
individuals were obese . There was no evidence of faulty oxygen supply 
during the flights. 

Pathologically, the chief features were: (1) evidence of circulatory 
collapse; {2) the presence of intense generalized lipemia and fat emboli in the 
kidney in one case and fat emboli in the lungs and brain in the other; (3) a 
patent foramen ovale in both with enlargement of the heart in one; (4) many 
foci of ischemic necrosis in the brain, indistinguishable from those due to 
air embolism; and (5) acute ischemic change iii the spinal cord in one of the 

From piecing together the observations, it is postulated that the follow- 
ing series of events occurred: As a consequence of fairly rapid decompres- 
sion, fat depots became supersaturated with gas. Gas bubbles formed in 
fat cells, rupturing them, and as a consequence fat gained access to the 
venous blood stream. Gas bubbles emanating from the region of fat depots 
were carried to the right side of the heart and thence to the lungs where many 
bubbles and fat emboli were filtered out (some may have passed the pulmonary 
filter). This tamponade of the pulmonary circulation produced an elevation of 
pulmonary blood pressure which was reflected in the right heart enabling 
blood laden with bubbles to traverse the foramen ovale and enter the general 
circulation. Thus, bubbles were carried in sufficient number to the brain 
to contribute to the fulminant circulatory collapse and death. (Medem No. 27, 
Armed Forces Institute of Pathology Letter, 8 May 1956) 

Medical News Letter, Vol. 27, No. 12 


Do the Eyes Have It ? 

In medicine, we have been trained to be as objective as possible. True, 
we are cognizant of the subjective. In many areas of medical history and 
physical examination, we accept certain amounts of subjectivity for it may 
be our only yardstick. This has been true in certain portions of the eye exam 
ination. Particularly, in connection with phorometry and, even with the Snel- 
len Chart, this is so. It is well known that many flight applicants, as well as 
other examinees, have been coached to pass the eye examination. While it 
is testimony to their desire to get into a particular program, be it Naval 
Aviation or the Naval Academy, it behooves the medical officer to determine 
in every case whether or not a man actually sees what he states he sees. 

The opposite is also true. The eye and its supporting physiological 
and anatomical appendages maybe adversely affected by fatigue, eye strain, 
and injudicious celebrations the night before — to mention but a few. It is then 
advisable to give the individual enough time to put his visual apparatus back 
into the state of "normalcy" prior to examination. 

As phoria examinations are subjective, it is often necessary to have 
additional information to validate these results. The procedures described 
below work very satisfactorily. Some of them are objective and involve 
harmless but justifiable trickery. Needless to say, phorias should be meas- 
ured before prism divergence and convergence as the extra ocular muscles 
fatigue easily during these examinations and will make phoria measurements 
variable. When, for any reason, the phoria values are questionable in the 
eyes of the examiner, one or more of the following will be of value in arriving 
at the truth. 

1. Switch the Maddox Rod to the opposite eye. Then, noting the eso- 
phoria or exophoria value from the first examination, set this value on 

the Risley Rotary Prism before swinging it in front of the eye. Then, very 
slowly turn the prism knob. Have the patient state when the light and line 
separate. Very small amounts of rotation will move the light away from 
the line normally. If, in these cases, an individual has learned to estimate 
when the line and light touch (by roughly knowing the distance between the 
light and line as he sees them), small amounts of movement of the Risley 
Rotary Prism will not be detected as motion of the light. Two to four 
diopter variations will be often reported as "no motion" or "they are still 
lined up. " This is impossible. 

2. Knowing the esophoria or exophoria value, set the Risley Rotary 
Prism 1 diopter away from the true value and swing the prism before the 
eye. The Maddox Rod is before the other eye. Turn the Risley knob so 
as to rotate the prism across the neutral point to 1 diopter the other side. 
Repeat this fairly rapidly. This should be reported by the subject as 
movement of the light to "right" then "left" and "right" or vice versa as 
the case may be. The educated guesser will often be unable to detect this 
relative movement correctly and will not report it as such. 


Medical News Letter, Vol. 27, No. 12 

3. Using simple prisms or the convenient prism bar, neutralize 
esophoria or exophoria for distance by the cover test. When the correct 
prism value is in front of the eye, there will be no drifting from fixation 
point at twenty feet when the eyes are alternately covered. This prism 
is the true esophoria or exophoria value. This is the one irrefutable 
objective test for phorias. 

4. In determining point of convergence using a muscle light attach- 
ment on the ophthalmoscope handle and watching the reflection of the light 
in the eyes, the earliest lateral drift of one eye can easily be detected. 

5. In cases where esophoria is more than 5 diopters or less than 10 
diopters, be reluctant to run the red lens test. Preferably, when there 
is doubt, recheck the phoria daily for the next few days. Incorporate any 
of the above three procedures as necessary. A red lens test should be run 
only once on an individual. A second test any time is often invalid because 
the person may well have learned "what he should see. " When doing a red 
lens test, always determine esophoria or exophoria when diplopia occurs. 
By recording esophoria or exophoria in the field of action of each muscle, 
the specific muscle imbalance or paralysis can be determined. 

6. Lack of sleep, excessive eye usage, or indulgence in alcohol the 
night before may affect true phoria values a great deal. The candidates' 
true eye measurements, whatever they are, is the goal. If the examiner 
uses all the aids at his disposal and arrives at the correct values, he then 
has answered the question, "Do the Eyes Have It. " (LT J.J. Gordon, MC 

USN, CVG-2) 


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